Esiti clinici delle cure domiciliari per il paziente oncologico terminale: uno studio condotto a Milano

Summary To evaluate the resource and the direct costs of palliative home care and analyse outcome (pain, pressure ulcers and dyspnea) in a population of terminally ill cancer patients at home, we conducted a prospective observational study in seven centers in Milan. Patients eligible for the study had a diagnosis of terminal stage cancer and an expected time to the end of his/her life less than 90 days and were observed for the first time during the period May 2005-May 2006. A total of 1081 patients entered the study. All patients were followed from recruitment to death, definitive hospital/palliative care unit admission or withdrawn from the study. Out of the 1081 study patients, 687 (63.6%) died at home, 178 (16.5%) in a palliative care unit, 140 (13.8%) in hospital and 67 (6.2%) withdrew the study. The mean number of visit per day of a physician was 0.35 (SD 0.27). The corresponding values for the visit of a nurse and of a social assistant/psychologist were 0.42 (SD 0.27) and 0.10 (SD 0.09). The mean direct cost was 411,49 euros/week. A total of 12 patients (1.1%) reported a VAS value for pain >5 in 2 or more consecutive measurements. Pressure ulcers were reported in 113 patients (10.5%) with a mean number of ulcers of 1.5 (SD 1.2). A VAS value for dyspnea >5 was reported in at least one measurement in 144 (13%) subjects; a value of 10 was reported by 12 (1.1%) subjects.